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Ruxience

rituximab
Used for Rheumatoid Arthritis, Leukemia, Non-Hodgkin Lymphoma
Used for Rheumatoid Arthritis, Leukemia, Non-Hodgkin Lymphoma

Riabni (rituximab or rituximab-arrx) is an anti-CD20 monoclonal antibody. It’s used to treat certain blood cancers (e.g., chronic lymphocytic leukemia) and autoimmune conditions (e.g., rheumatoid arthritis). Ruxience (rituximab) is given as an infusion through the vein (IV), usually at an infusion center. This is so your care team can monitor and treat you for any serious infusion-related reactions, such as trouble breathing and swelling. Other possible side effects of this medication include rash and infection. Ruxience (rituximab) is a biosimilar to Rituxan (rituximab), but it’s not yet FDA-approved to treat all conditions Rituxan (rituximab) is approved for.

Reviewed by:
reviewer
Allison Baxley, PharmD, BCOP
reviewer
Connie Zheng, PharmD
Last reviewed on May 19, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsAlternativesLatest newsReferencesPricesMedicare
basics-icon

What is Ruxience (rituximab)?

What is Ruxience (rituximab) used for?

Blood cancers

Autoimmune conditions

How Ruxience (rituximab) works

Ruxience (rituximab) is an anti-CD20 monoclonal antibody. It targets specific cells in your immune system called B cells. B cells are involved in many different health conditions. For example, sometimes they can turn into cancer cells, and other times they become too active, which can cause autoimmune conditions.

Ruxience (rituximab) works by attaching to a specific protein in B cells called CD20. When it attaches to this protein, it signals the body to attack and kill that cell. As a result, these abnormal or overactive B cells can’t grow, spread, or work as well.

Are you looking for information on Rituxan (rituximab) instead?

Drug Facts

Common BrandsRuxience
Drug ClassAnti-CD20 monoclonal antibody
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only

More on Ruxience (rituximab) essentials

rituximab: biosimilars: still life injection 1289345741

Is There a Biosimilar to Rituximab? Yes, Here Are 3 Rituximab Biosimilars You Should Know

Written by Rachel Feaster, PharmD, BCOP, BCPS
basics-icon

What are the side effects of Ruxience (rituximab)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Fever (up to 53%)
  • Lower white blood cell count (48%)
  • Chills (up to 33%)
  • Infection (31%)
  • Weakness (up to 26%)
  • Nausea (up to 23%)
  • Headache (up to 19%)
  • -Diarrhea (up to 17%)
  • Muscle spasms (up to 17%)
  • Lower red blood cell count (up to 16%)
  • Swelling (up to 16%)
  • Night sweats (15%)
  • Rash (15%)

Other Side Effects

  • Trouble sleeping
  • Stomach pain
  • Cough
  • Itching
  • Vomiting
  • Joint stiffness
  • Nosebleeds
  • Runny nose
  • Tiredness

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Infusion-related reaction: swelling, trouble breathing, chest pain, low blood pressure, red skin
  • Serious skin reaction: painful blisters, skin wounds, peeling skin, fever, sore throat, body aches
  • Tears in the gut: sudden and severe stomach pain, fever, chills, and nausea or vomiting that won’t go away
  • Infection: fever, chills, cough, muscle aches, very fast heartbeat, severe tiredness
  • Tumor lysis syndrome: seizures, hallucinations, nausea, tiredness, no appetite, dark-colored urine, muscle cramps, numbness
  • Serious heart problems: tiredness, weakness, dizziness, feeling faint, trouble breathing, pressure on the chest, pounding heart, irregular heart beat, sweating, feeling anxious, nausea

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Black, tarry stools

bleeding gums

bloating or swelling of the face, arms, hands, lower legs, or feet

blood in the urine or stools

blurred vision

body aches or pain

burning or stinging of the skin

chest pain

chills

confusion

cough

difficulty with breathing

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

drowsiness

dry mouth

ear congestion

fever

flushed, dry skin

fruit-like breath odor

headache

hives or welts, itching, rash

increased hunger

increased thirst

increased urination

large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or genitals

lower back or side pain

nausea

nervousness

noisy breathing

pain or tenderness around the eyes and cheekbones

painful cold sores or blisters on the lips, nose, eyes, or genitals

painful or difficult urination

pale skin

pinpoint red spots on the skin

pounding in the ears

seizures

slow or fast heartbeat

sneezing

sore throat

sores, ulcers, or white spots in the mouth or on the lips

stomach pain

stuffy or runny nose

sweating

swelling of the tongue or throat

swollen glands

tightness of the chest

tingling of the hands or feet

troubled breathing with exertion

unusual bleeding or bruising

unusual tiredness or weakness

unusual weight gain or loss

vomiting

Less common

Blistering, peeling, or loosening of the skin

blisters on the trunk, scalp, or other areas

burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feeling

decreased frequency and amount of urine

diarrhea

difficulty with moving

discouragement

feeling sad or empty

irregular heartbeat

irritability

joint or muscle pain

loss of appetite

loss of interest or pleasure

lump or growth on the skin

muscle cramp, pain, or stiffness

numbness or tingling in the hands, feet, or lips

painful blisters on the trunk of the body

pain or redness at the injection site

pain, swelling, or redness in the joints

pounding or irregular heartbeat or pulse

red skin lesions, often with a purple center

red, itchy lining of the eye

redness of the face, neck, arms, and occasionally, upper chest

stabbing pain

trouble concentrating

trouble sleeping

Incidence not known

Blue-yellow color blindness

blurred vision or other change in vision

burning or stinging of the skin

decreased vision

dilated neck veins

dry cough

extreme tiredness or weakness

eye pain, tearing

feeling of discomfort, illness, or weakness

irregular breathing

nosebleed

painful cold sores or blisters on the lips, nose, eyes, or genitals

sensitivity of the eye to light

severe abdominal or stomach pain

severe vomiting, sometimes with blood

sores, welts, or blisters

stomach cramps

swelling, stiffness, redness, or warmth around many joints

swollen lymph glands

vision loss

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Fear

hair loss

lack or loss of strength

night sweats

thinning of the hair

throat irritation

Less common

Agitation or anxiety

bone pain

burning, dry, or itching eyes

change in taste

discharge, excessive tearing

dry eyes

excessive muscle tone

feeling of constant movement of self or surroundings

heartburn

increase in body movements

lightheadedness

muscle tension

redness, pain, or swelling of the eye, eyelid, or inner lining of the eyelid

sensation of spinning

sleepiness

swelling of the stomach

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Ruxience (rituximab)

thumbs-up

Pros

Works in a more targeted, specific way than chemotherapy

Might only need a dose once every 6 months for certain conditions

Doesn’t typically cause hair loss

thumbs-down

Cons

Each infusion can last over 3 hours, so can be inconvenient

Might cause infusion reactions

Higher risk of infections can last a year after your last dose (sometimes longer)

pharmacist-tips

Pharmacist tips for Ruxience (rituximab)

pharmacist

  • How often you need a Ruxience (rituximab) infusion depends on your medical condition and how your body responds to the medication. Make sure you know when your infusions are scheduled and mark the dates on your calendar so you don’t miss a treatment. There are also several apps for your phone that can help you keep track.

    • Each Ruxience (rituximab) infusion appointment can last almost the full day because of the time it takes to receive premedications and Ruxience (rituximab) infusion. Please plan accordingly for this time. Make sure you dress comfortably, bring water and food, and have something to help you pass the time, such as a book or music.

      • Your oncologist will give you premedications, such as steroids, acetaminophen (Tylenol), and antihistamines, before each Ruxience (rituximab) infusion. These medications can help lower the risk of an infusion-related reaction, which can be very serious.

        • Check your temperature regularly, such as once a day, when you’re receiving Ruxience (rituximab) treatment. Call your care team immediately if your temperature is 100.4 degrees Fahrenheit or higher; this means you have a fever. It’s important for your oncologist to know if you get sick, and sometimes a fever might be the only sign that you’re sick.

          • If you experience nausea and vomiting while receiving Ruxience (rituximab), contact your oncologist. There are several antiemetic medications, such as ondansetron (Zofran) or promethazine (Phenergan), your oncologist might prescribe to help manage it.

            • We don’t know if Ruxience (rituximab) passes into human milk. But, because of the risks to a nursing infant, you shouldn’t breastfeed while taking Ruxience (rituximab) and for 6 months after the last dose.

              faqs

              Frequently asked questions about Ruxience (rituximab)

              Is Ruxience (rituximab) chemotherapy or immunotherapy?
              Ruxience (rituximab) works more like an immunotherapy than a chemotherapy. Chemotherapy works by attacking all cells that grow very quickly, while immunotherapy works by using your own immune system to target cancer cells. But there are actually many types of immunotherapy for cancer and they affect your immune system differently. For example, some medications activate all of your immune cells to fight cancer. But other medications, like Ruxience (rituximab), only target specific immune cells. So while Ruxience (rituximab) is sometimes referred to as immunotherapy in the broad sense of the term, it's more often considered a targeted therapy.
              Does Ruxience (rituximab) cause infusion reactions?
              People taking Ruxience (rituximab) might experience infusion reactions. These reactions are most common during the first infusion. Symptoms might include rash and red skin, chest pain, swelling, and trouble breathing. Some people have reported life-threatening reactions, such as throat swelling, anaphylaxis, or heart attacks. Your oncologist will give you several medications, such as acetaminophen (Tylenol) and diphenhydramine (Benadryl), before your Ruxience (rituximab) dose to lower your risk of a reaction. Your nurse will also monitor you very closely, especially during your first dose. You should tell your nurse right away if you have symptoms of a reaction during your treatment.
              What should I avoid after Ruxience (rituximab) infusion?
              There aren’t any specific foods or drinks you need to avoid after receiving Ruxience (rituximab). It’s a good idea to stay home and rest the day after your infusion, especially after the first few doses when you’re still learning how your body might react to the medication. It’s possible that you might experience an infusion-related reaction up to 24 hours after your treatment. Tell your oncology care team right away if you experience symptoms, such as trouble breathing or rash, so you can get immediate medical attention.
              How long do Ruxience (rituximab) side effects last?
              How long the side effects Ruxience (rituximab) last can differ depending on what side effects you’re experiencing. For example, fever, rash, muscle pain from infusion-related reactions can appear quickly, often times within 2 hours of an Ruxience (rituximab) infusion. But these side effects are short-lived because your care team can help you manage them quickly with other medications. Other side effects of Ruxience (rituximab), such as having a weaker immune system (from low white blood cell counts), can last months after your last dose. Talk to your oncologist if you have questions on any particular Ruxience (rituximab) side effect.
              What does it mean that Ruxience (rituximab) is a biosimilar?
              Ruxience (rituximab) is a biosimilar to Rituxan (rituximab). A biosimilar is a biologic medication that’s very similar to the original biologic that was first approved by the FDA. Biosimilars are as safe and work similarly as well as the original biologic medication. Ruxience (rituximab) isn’t approved to treat all the same conditions or all the same age groups as Rituxan (rituximab). Talk to your oncologist if you have questions about biosimilars.
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              warings-icon

              What are the risks and warnings for Ruxience (rituximab)?

              Ruxience (rituximab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Infusion-related reactions

              People taking rituximab products might experience infusion-related reactions. These reactions are most common within the first two hours of the first infusion. Symptoms include rash and red skin, swelling, trouble breathing, chest pain, irregular heartbeat, and low blood pressure. Sometimes, these reactions can be very serious and cause throat swelling, anaphylaxis, or heart attacks. This can be life threatening.

              You’ll take several medications before each treatment, such as acetaminophen (Tylenol) and diphenhydramine (Benadryl) to help prevent a reaction. Your nurse will watch you closely during your first treatment, but you should tell them right away if you experience any symptoms during your treatment. If you have a severe reaction to Ruxience (rituximab), you might not be able to continue taking the medication.

              risk-warning

              Serious skin reactions

              Some people receiving rituximab products have experienced serious and sometimes life-threatening skin problems, such as Stevens-Johnson syndrome (SJS), paraneoplastic pemphigus, toxic epidermal necrolysis (TEN), and others. Tell your provider right away if you develop painful blisters, skin wounds, peeling skin, or fever as these are signs of a serious skin reaction that need immediate medical attention.

              risk-warning

              Hepatitis B reactivation

              • Risk factors: History of hepatitis B viral infection

                Some people who had hepatitis B in the past experienced a new infection (hepatitis B reactivation) after starting medications like rituximab. Your oncologist will test you for hepatitis B virus before you start taking Ruxience (rituximab). If you test positive, you might need treatment for hepatitis B before you start taking Ruxience (rituximab). If you develop a hepatitis B infection during treatment, you’ll need to stop taking Ruxience (rituximab) while your oncologist treats it. Let your oncologist know right away if you experience symptoms of an active hepatitis B infection, such as fever, tiredness, or yellowing of the skin.

                risk-warning

                Progressive multifocal leukoencephalopathy

                • Risk factors: Taking Ruxience (rituximab) with chemotherapy | Taking Ruxience (rituximab) for stem cell transplant

                  Rarely, people taking Ruxience (rituximab) have developed a serious brain condition called progressive multifocal leukoencephalopathy (PML). PML is caused by a virus called JC virus and can lead to brain damage. Let your oncologist know if you’ve PML symptoms while taking Ruxience (rituximab), such as weakness, clumsiness, difficulty speaking, and difficulty walking.

                  risk-warning

                  Tumor lysis syndrome

                  • Risk factors: People taking Ruxience (rituximab) for lymphoma

                    Some people taking medications like Ruxience (rituximab) to treat cancer developed a complication called tumor lysis syndrome (TLS) that can cause damage in multiple areas of the body. TLS happens when cancer cells are destroyed and release what’s inside them, such as potassium and uric acid, into your blood. TLS is most common during the first treatment cycle, and symptoms can appear within 24 hours of the Ruxience (rituximab) infusion. Your oncologist will closely monitor you with lab tests, and might give you extra fluids or a medication such as allopurinol (Zyloprim) to prevent TLS. Let your oncology care team know if you experience symptoms of TLS, such as nausea, tiredness, and no appetite.

                    risk-warning

                    Serious infections

                    • Risk factors: Taking Ruxience (rituximab) with chemotherapy

                      People who take rituximab products like Ruxience (rituximab) can develop serious infections, including viral, bacterial, and fungal infections. If you do get sick, you might need to pause taking Ruxience (rituximab) and start taking other medications to treat the infection. If you develop a serious infection you might have to stop taking Ruxience (rituximab) altogether. Contact your oncologist if you develop signs and symptoms of an infection such as fever, chills, muscle aches, or severe tiredness or weakness.

                      risk-warning

                      Serious heart problems

                      Serious heart problems have happened during treatment with medications like Ruxience (rituximab). These include heart rhythm changes and heart attacks. If your heart rhythm changes during your treatment, your oncologist might recommend closer monitoring with a test called an electrocardiogram (EKG) during your infusions. If you develop serious heart problems during treatment, your oncologist might stop your Ruxience (rituximab) infusion.

                      risk-warning

                      Kidney problems

                      Risk factors: Tumor lysis syndrome | Taking cisplatin
                      Some people taking medications like Ruxience (rituximab) experienced kidney problems. This was more common in people who developed tumor lysis syndrome or who were taking Ruxience (rituximab) together with a chemotherapy medication called cisplatin. Your oncologist will monitor your kidney health with a blood test while you’re taking Ruxience (rituximab). Let your oncologist know if you have trouble making urine, notice swelling in your hands and feet; these might be symptoms of kidney problems.

                      risk-warning

                      Gut blockage and tears

                      Some people have reported stomach pain, intestinal blockage, and tears in the lining of the gut after starting medications like Ruxience (rituximab) together with chemotherapy for NHL. For some people, these side effects appeared 2 months after the start of treatment. Contact your oncologist right away if you have sudden and severe stomach pain, fever, chills, and nausea or vomiting that won’t go away.

                      risk-warning

                      Vaccines

                      Make sure you’re up-to-date with your vaccines before starting Ruxience (rituximab). We don’t know if it’s safe to take live virus vaccines while taking Ruxience (rituximab). You should avoid live vaccines during treatment. And you need to receive any non-live vaccines at least 4 weeks before Ruxience (rituximab) treatment. Talk to your oncologist before getting any vaccine while you’re taking Ruxience (rituximab), even if it’s an inactivated vaccine.

                      risk-warning

                      Harm to unborn baby

                      Based on data from human pregnancies, Ruxience (rituximab) can cause harm to an unborn baby. If you’re a female who's able to have babies, you should use effective birth control while taking Ruxience (rituximab) and for 12 months after the last dose. Contact your oncologist right away if you become pregnant while taking Ruxience (rituximab).

                      risk-warning

                      Combination treatment for people with autoimmune conditions

                      Risk factors: People taking Ruxience (rituximab) for autoimmune conditions
                      We don’t know if it’s safe to take other biologic medications or disease-modifying antirheumatic drugs (DMARDs) together with Ruxience (rituximab). Because taking these medications together might raise your risk for infection, your provider will closely monitor you if they recommend a combination treatment.

                      dosage

                      Ruxience (rituximab) dosage forms

                      Typical dosing for Ruxience (rituximab)

                      Blood cancers

                      Your oncologist will determine your dose of Ruxience (rituximab) based on your body surface area (BSA) in m². Your oncologist might also give you other anticancer medications along with Ruxience (rituximab).

                      • Non-Hodgkin’s lymphoma

                        • Adults: The typical dose is 375 mg/m² given as an intravenous infusion. How often you’ll receive a dose usually ranges from weekly to every 8 weeks, depending on the type of NHL you have and where you are in the treatment process.

                      • Chronic Lymphocytic Leukemia (CLL)

                        • Adults: The typical dose is to receive one 375 mg/m² intravenous infusion before the start of chemotherapy. Then, your oncologist will raise your dose to 500 mg/m² infused on Day 1 of a 28-day chemotherapy cycle, for up to 6 cycles.

                      Autoimmune conditions

                      Your HCP might also give you other medications along with Ruxience (rituximab) to treat your condition.

                      • RA

                        • Adults: The typical starting dose is 1,000 mg infused IV for 2 doses, given 2 weeks apart. The typical maintenance dose is 1,000 mg infused once every 4 to 6 months, depending on your condition.

                      • GPA and MPA

                        • Adults: Your HCP will determine your dose of Ruxience (rituximab) based on your body surface area (BSA) in m². The typical starting dose is 375 mg/m² given as an intravenous infusion weekly for 4 weeks. The typical maintenance dose is 500 mg given as 2 doses 2 weeks apart, then 500 mg every 6 months.

                      interactions

                      Interactions between Ruxience (rituximab) and other drugs

                      Ruxience (rituximab) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Ruxience (rituximab). Please note that only the generic name of each medication is listed below.

                      Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

                      Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                      Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                      Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                      • Influenza Virus Vaccine (Subvirion)
                      • Pneumococcal Vaccine Polyvalent
                      alternatives

                      What are alternatives to Ruxience (rituximab)?

                      There are a number of medications that your doctor can prescribe in place of Ruxience (rituximab). Compare a few possible alternatives below.
                      Ruxience (rituximab)
                      Used for:

                      Blood cancers

                      Autoimmune conditions

                      View Prices
                      Humira (adalimumab)
                      Used for:

                      • Rheumatoid arthritis (RA) - adults only

                      • Juvenile idiopathic arthritis (JIA) - people age 2 and older

                      • Psoriatic arthritis (PsA) - adults only

                      • Ankylosing spondylitis (AS) - adults only

                      • Crohn's disease (CD) - people age 6 and older

                      • Ulcerative colitis (UC) - people age 5 and older

                      • Plaque psoriasis - adults only

                      • Hidradenitis suppurativa (HS) - people age 12 and older

                      • Uveitis - people age 2 and older

                      $1317.30 Lowest GoodRx priceView Prices

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                      References

                      Best studies we found

                      Adeyinka, A., et al. (2022). Tumor lysis syndrome. StatPearls.

                      American Cancer Society. (2024). Fevers.

                      American Cancer Society. (2024). Infusion or immune reactions.

                      View All References (15)

                      Bartels, T., et al. (2020). Utilizing a novel four-drug regimen to reduce the incidence of infusion-related reactions for first-dose rituximab infusions: An institutional review of rituximab infusion-related reactions in lymphoma patients. Journal of Clinical Oncology. 

                      Benjamin, O., et al. (2023). Disease-modifying antirheumatic drugs (DMARD). StatPearls.

                      Fouda, G. E., et al. (2020). Rituximab hypersensitivity: From clinical presentation to management. Frontiers in Pharmacology.

                      Genentech USA, Inc. (n.d.). What are granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA)?

                      Gupta, A., et al. (2018). Tumor lysis syndrome. Journal of the American Medical Association Oncology.

                      Hafner, J., et al. (2023). Intestinal perforation. StatPearls.

                      Hanif, N., et al. (2024). Rituximab. StatPearls.

                      Kappius, R. H., et al. (2023). Paraneoplastic pemphigus. StatPearls.

                      National Comprehensive Cancer Network. (2021). Anemia and neutropenia: Low red and white blood cell counts.

                      National Institute of Neurological Disorders and Stroke. (2024). Progressive multifocal leukoencephalopathy.

                      Pavlasova, G., et al. (2020). The regulation and function of CD20: An "enigma" of B-cell biology and targeted therapy. Haematologica.

                      Pfizer Laboratories Div Pfizer Inc. (2024). Ruxience- rituximab-pvvr injection, solution [package insert]. DailyMed.

                      Saribas, A. S., et al. (2010). JC virus-induced progressive multifocal leukoencephalopathy. Future Virology.

                      Smith, D. A., et al.(2023). Bowel obstruction. StatPearls.

                      U.S. Food and Drug Administration. (2023). Biosimilars.

                      GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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